Workers’ Compensation Claims for Musculoskeletal Disorders Among Wholesale and Retail Trade Industry Workers — Ohio, 2005–2009

Work-related musculoskeletal disorders (WMSDs) resulting from ergonomic hazards are common in the United States. Recent data from the Bureau of Labor Statistics (BLS) indicate that in 2011, one third of occupational injuries and illnesses resulting in lost time from work were WMSDs. Based on data from the 2010 BLS Survey of Occupational Injuries and Illnesses, a higher rate of WMSDs resulting in lost time from work occurred in the Wholesale and Retail Trade (WRT) industry compared with most other industries. To assess trends and identify WRT subsectors and subgroups associated with high rates of WMSD workers' compensation claims, the Ohio Bureau of Workers' Compensation (OBWC) and CDC analyzed OBWC claims data for single-location WRT employers in Ohio for the period 2005-2009. From 2005 to 2009, the rate of WMSD claims declined from 86.3 to 52.8 per 10,000 employees. The three WRT industry subsectors with the highest rates of WMSD claims were Merchant Wholesalers, Nondurable Goods; Furniture and Home Furnishings Stores; and Merchant Wholesalers, Durable Goods. Within those three WRT subsectors, the highest rates of WMSD claims were noted in five subgroups: furniture stores and wholesalers of alcoholic beverages, groceries and related products, metal and minerals, and motor vehicle parts. Providing recommendations for WMSD prevention is particularly important for these WRT subgroups.

Work-related musculoskeletal disorders (WMSDs) resulting from ergonomic hazards are common in the United States. Recent data from the Bureau of Labor Statistics (BLS) indicate that in 2011, one third of occupational injuries and illnesses resulting in lost time from work were WMSDs (1). Based on data from the 2010 BLS Survey of Occupational Injuries and Illnesses, a higher rate of WMSDs resulting in lost time from work occurred in the Wholesale and Retail Trade (WRT) industry compared with most other industries (2). To assess trends and identify WRT subsectors and subgroups associated with high rates of WMSD workers' compensation claims, the Ohio Bureau of Workers' Compensation (OBWC) and CDC analyzed OBWC claims data for single-location WRT employers in Ohio for the period [2005][2006][2007][2008][2009]. From 2005 to 2009, the rate of WMSD claims declined from 86.3 to 52.8 per 10,000 employees. The three WRT industry subsectors with the highest rates of WMSD claims were Merchant Wholesalers, Nondurable Goods; Furniture and Home Furnishings Stores; and Merchant Wholesalers, Durable Goods. Within those three WRT subsectors, the highest rates of WMSD claims were noted in five subgroups: furniture stores and wholesalers of alcoholic beverages, groceries and related products, metal and minerals, and motor vehicle parts. Providing recommendations for WMSD prevention is particularly important for these WRT subgroups.
OBWC is the largest of four state-run workers' compensation systems in the United States where the state is the sole provider of workers' compensation insurance.* Data for OBWC-insured, single-location † employers in the WRT industry were used for this report; subsectors and subsector groups were categorized according to the North American Industry Classification System (NAICS). With few exceptions, WMSD claims were defined according to BLS case definitions. § Coded injury/illness diagnosis data and narrative text on causation were used to identify WMSD claims; a Bayesian auto-coding technique (3) used both data elements to identify WMSDs by using a "training" and "testing" set of manually coded claims. The sensitivity and specificity of this auto-coding technique when applied to a test set were 0.90 and 0.98, respectively. Auto-coded WMSD claims were flagged for manual, expert review when the injury/illness diagnosis was not a WMSD. Lost-time claims for WMSDs were defined as claims resulting in more than 7 days away from work. To calculate incidence rates, OBWC claims data were linked with denominator data (number of employees) from the Ohio Department of Jobs and Family Services by federal employer identification numbers. Trends in rates were tested using Poisson regression analysis. Disallowed and dismissed claims were excluded from all analyses.
In  Table 2). The high lost-time WMSD rates in these three WRT subsectors were consistently attributable to high rates in five subgroups within the subsectors: wholesalers of alcoholic beverages (114.8 in 2009), grocery and related products (30.9), metal and minerals (28.0), and motor vehicle parts and supplies (25.4); and furniture stores (27.2).

Workers' Compensation Claims for Musculoskeletal Disorders Among Wholesale and Retail Trade Industry Workers -Ohio, 2005-2009
* All public Ohio employers and private employers (except sole proprietorships or partnerships) with fewer than 500 employees must participate in the OBWC system. Other private employers have the option to self-insure for workers' compensation insurance. OBWC provides workers' compensation insurance for approximately two thirds of Ohio workers but a smaller proportion of WRT workers. † OBWC claims cannot be linked to a particular employer if the policy includes more than one location. Therefore, these analyses are confined to single-location employers. In 2009, among identified OBWC-insured WRT employers, employees at 31,599 single-location employers filed 7,661 workers' compensation claims and employees at 882 multiple-location employers filed 3,441 claims. § BLS case definitions are available at http://www.bls.gov/iif/oshdef.htm. This analysis used a definition for musculoskeletal disorders that included Raynaud's phenomenon, tarsal tunnel syndrome, and herniated spinal discs, similar to the revised BLS case definition (2011 and forward). Also, the work-related musculoskeletal disorders case definition used in this analysis excluded events or exposures resulting from a single episode of overexertion/bodily reaction from climbing down, stepping down, or walking or running without other incident (i.e., missteps).

Reported by
Ibraheem Tarawneh

Editorial Note
Improved surveillance of work-related WMSDs is a national priority (4). This report demonstrates how workers' compensation claims data can be used for public health surveillance.
The results indicate that although the rate of WMSD claims (overall and lost-time) among workers employed by OBWCinsured employers declined from 2005 to 2009 for most WRT subsectors, workers in some subsectors experienced higher rates of WMSD claims than workers in other WRT    (2). For all workers' compensation claims and industry sectors, the National Council on Compensation Insurance has reported downward trends among many states since the 1990s (5), attributing the trends, at least in part, to 1) advances in automation, technology, and production; 2) an aging workforce (older workers tend to have fewer claims [6]); and 3) increased focus on workplace safety and loss control. Workers in the WRT subsectors with the highest rates of workers' compensation claims are exposed to physical risk factors for WMSDs such as overexertion or repetitive motion (7). Work tasks in subgroups among those with the highest claim rates within the WRT subsectors (e.g., furniture stores and wholesalers of alcoholic beverages) commonly include lifting and transporting large, heavy objects. The Occupational rates by WRT subsector. Finally, studies have estimated that workers' compensation claims data underreport work-related injuries and illnesses by 40%-80% (8-10). However, whereas underreporting of injuries and illnesses might reduce the size of claim rates, whether the differences observed among WRT subsectors or employers of different sizes were affected by underreporting is unknown. The findings in this report suggest that the number and rate of WMSD claims declined from 2005 to 2009 among small WRT employers in Ohio, but relatively high rates of WMSD claims occurred among certain WRT subsectors and subgroups. Interventions to reduce exposure to ergonomic hazards in these subsectors and subgroups should continue to be developed and Safety & Health Administration has created ergonomic training tools that outline injury prevention activities for beverage delivery and grocery warehousing. ¶ Certain interventions (e.g., stair-climbing dollies, keg-handling equipment, and forklifts) can reduce many but not all manual material-handling tasks in these subgroups.
The findings in this report are subject to at least three limitations. First, this report is only representative of smaller employers (<500 employees) with a single location in Ohio. Second, the Bayesian auto-coding method used to identify WMSD claims introduces the potential for misclassification. However, misclassification is not expected to create bias in WMSD ¶ Available at http://www.osha.gov/dts/osta/oshasoft/index.html.

FIGURE. Rates of workers' compensation claims for musculoskeletal disorders resulting in lost-time per 10,000 employees, among the WRT NAICS subsectors with the highest rates -Ohio, 2005-2009
implemented to prevent WMSDs. Given the large workforce employed in the WRT industry, declines in the number of WMSDs could substantially reduce the number of workplace injuries and illnesses overall.
What is already known on this topic? Workers in the Wholesale and Retail Trade (WRT) industry have more work-related musculoskeletal disorders (WMSDs) resulting in lost work days than do most other workers.
What is added by this report?
Based on an analysis of claims filed with the Ohio Bureau of Workers' Compensation by single-location WRT employers, WMSD claims decreased from 86.3 per 10,000 employees in 2005 to 52.8 in 2009. The WRT industry subsectors with the highest rates of WMSD claims during 2005-2009 were Wholesalers, Nondurable Goods; Furniture and Home Furnishings Stores; and Wholesalers, Durable Goods. Within those three WRT subsectors, the highest rates of WMSD claims were noted in five subgroups: furniture stores and wholesalers of alcoholic beverages, groceries and related products, metal and minerals, and motor vehicle parts.
What are the implications for public health practice?
Although the rate of claims for WMSD resulting in lost work days has decreased in the WRT industry in Ohio, workers continue to experience WMSDs, and some WRT subsectors are experiencing higher rates of WMSD claims than others. Prevention efforts are most needed in the WRT subgroups, wholesalers of alcoholic beverages and groceries and related products.